Fernanda Geraldo Pappen

Pulp Tissue Dissolution Capacity of Sodium Hypochlorite Combined with Cetrimide and Polypropylene Glycol

This study evaluated the influence of the addition of cetrimide and polypropylene glycol to sodium hypochlorite (NaOCl) on its capacity to dissolve pulp tissue. Bovine pulp fragments with standardized weight and volume were immersed for 5, 15 and 30 min in 2 mL of NaOCl and Hypoclean (NaOCl added with cetrimide and polypropylene glycol) solutions at 5.25%, 2.5%, 1%, 0.5% and 0.25% and afterwards re-weighted. Distilled water was used as a control. The percentage of tissue loss was considered for statistical analysis (univariate ANOVA, SPSS, v. 17.0) at 5% significance level. There was no tissue dissolution in the control group. NaOCl added with surfactants (Hypoclean) dissolved more pulp tissue (p<0.05) than NaOCl alone. Tissue dissolution was directly dependent on the concentration of solutions (p<0.05), and also on the time range (p<0.05). The combination of NaOCl at high and low concentrations with the surfactants cetrimide and polypropylene glycol increased significantly its capacity to dissolve pulp tissue.

Are Premixed Calcium Silicate–based Endodontic Sealers Comparable to Conventional Materials? A Systematic Review of In Vitro Studies

Introduction This study aimed to compare the physicochemical and biological properties of premixed calcium silicate–based endodontic sealers with other conventional root canal filling materials by systematically reviewing laboratory studies. Methods The search was conducted in 3 databases (Medline via PubMed, Scopus, and Web of Science) following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. Two reviewers independently selected the studies and extracted the data. The properties of interest were bond strength, radiopacity, pH, solubility, setting and working time, dimensional change, flow, calcium ion release, antimicrobial activity, biocompatibility, and cytotoxicity. Results From 2636 potentially eligible studies, 31 were selected for full‐text analysis, and 27 were included in the review. Premixed calcium silicate–based endodontic sealers followed the ISO 6876:2012 requirements for most physicochemical properties except for solubility. The target sealers also presented favorable biological findings when compared with conventional sealers. Conclusions Despite the lack of well‐designed long‐term clinical trials, the target premixed calcium silicate–based sealers show good physicochemical and biological properties in vitro. In general, the results were similar or better than conventional endodontic sealers as observed in in vitro and in vivo animal studies. HighlightsCalcium silicate‐based sealers showed proper physicochemical properties.Calcium silicate‐based sealers presented optimal biological properties.

Similar Influence of Stabilized Alkaline and Neutral Sodium Hypochlorite Solutions on the Fracture Resistance of Root Canal-treated Bovine Teeth

INTRODUCTION Stabilizing sodium hypochlorite (NaOCl) at an alkaline pH is proposed to increase solution stability and tissue dissolution ability; however, a reduction on the flexural strength of dentin discs has been found to be a side effect. This study sought to determine whether a stabilized alkaline NaOCl reduces the fracture resistance of root canal-treated bovine teeth after root canal preparation compared with a neutral solution counterpart. METHODS The 4 anterior incisors were removed from 20 mandibular bovine jaws, and each 1 was randomly assigned to 1 of 4 groups (20 teeth each). Teeth were prepared with a sequence of 6 K-type files. The following experimental groups received a different irrigation regimen: G1: distilled water (negative control), G2: 5% NaOCl at a pH of 7.2, and G3: 5% NaOCl at a pH of 12.8; in the positive control group (G4), teeth remained untreated. The time of contact and volume of solution were carefully standardized. After bone and periodontal ligament simulation, teeth were subjected to a fracture resistance test. RESULTS A significant difference was observed among the 4 groups tested (analysis of variance, P < .05). The 5% NaOCl groups (G2 and G3) presented significantly lower resistance to fracture than the control (G1 and G4) (Tukey test, P < .05). Both NaOCl solutions similarly reduced the fracture resistance at approximately 30% (Tukey test, P > .05). No differences were observed between positive and negative control groups (Tukey test, P > .05). CONCLUSIONS Stabilized alkaline and neutral NaOCl solutions similarly reduced the fracture resistance of root canal-treated bovine teeth by about 30%.

Apical Extrusion of Debris and Irrigants Using Different Irrigation Needles

This study evaluated the influence of irrigation tip, root canal curvature and final apical diameter on periapical debris and irrigant extrusion during root canal instrumentation. After being classified as mildly or moderately curved, the mesiobuccal root canals of 90 human molars were instrumented. The teeth were allocated into three groups according to the used needle type: a flat open-end needle (Group 1), a side-vented needle (Group 2) or a double side-vented needle (Group 3). The amount of extruded material after instrumentation was calculated for each group. The differences in irrigant and debris extrusion between the experimental groups were analyzed with the Mann-Whitney U test. Irrigation tips and final instrument diameter differences were analyzed with the Kruskal-Wallis test. Multiple groups were compared using the Mann-Whitney U-test with a Bonferroni correction at α=0.05. The amount of extruded material from the double side-vented needle was significantly less than the open-ended flat needle (p=0.008), but there was no difference compared to the side-vented needle (p=0.929). The results showed no effect of root curvature and final apical diameter on the amount of irrigant and debris extrusion (p>0.05). The double side-vented needles generated the least material extrusion to the periapical tissues. Irrigation needle type had the greatest influence on periapical irrigant and debris extrusion and the double side-vented needles may be safely used during endodontic therapy.

Synthesis of silver-containing calcium aluminate particles and their effects on a MTA-based endodontic sealer

OBJECTIVE To synthetize calcium aluminate (C3A) and silver-containing C3A particles (C3A+Ag) testing their effects on the properties of a MTA-based endodontic sealer in comparison to an epoxy resin- and a calcium silicate-based sealer. METHODS Pure C3A and C3A+Ag particles were synthesized by a chemical method and characterized using XRD to identify crystalline phases. SEM/EDS analysis investigated morphology, particle size, and elemental composition of particles. Setting time, flow, radiopacity, water sorption and solubility of commercial and modified sealers were evaluated according to ISO 6876/2012. The pH and ions release were measured using a pHmeter and a microwave induced plasma optical emission spectrometer. The inhibition of biofilm growth was evaluated by confocal laser scanning microscopy (CLSM). Data were rank transformed and analyzed by ANOVA and Tukey test (P<0.05). RESULTS The C3A particles showed an irregular grain agglomerated structure with voids and pores. In C3A+Ag particles, Ag modified the material morphology, confirming the deposition of Ag. The physicochemical properties of the modified MTA-based sealer were similar to the commercial material, except for the significant increase in Ca+2 release. However, there was no Ag release. Setting time, flow, radiopacity, water sorption and solubility were adequate for all materials. All the materials showed alkaline pH. Antibiofilm effect was improved in the presence of C3A particles, while the biofilm inhibition was lower in the presence of Ag. SIGNIFICANCE The modified sealer presented improved antibiofilm properties and calcium release, without dramatic effects on the other characteristics. It is expected a positive effect in its antimicrobial behavior.

Periodontal Health Status and Associated Factors: Findings of a Prenatal Oral Health Program in South Brazil

Objective. The aims of this study were to evaluate the periodontal health of pregnant women and to investigate the association of periodontal status with demographic and socioeconomic characteristics, as well as medical and dental history. Materials and Methods. A total of 311 pregnant women were interviewed to obtain sociodemographic data along with medical and dental histories. Clinical examinations were performed to record the presence of visible plaque, gingival bleeding, and caries activity. The periodontal condition was evaluated by Community Periodontal Index of Treatment Needs (CPITN) in one tooth of each sextant (16, 11, 26, 36, 31, and 46). Results. After the adjustment analysis, the presence of visible plaque remained the main determinant of gingival bleeding (OR = 2.91, CI = 1.91–4.48). First-trimester pregnancy status was also a predictor, with a lower prevalence of gingival bleeding observed in the second (OR = 0.87, CI = 0.77–0.99) and third (OR = 0.82, CI = 0.73–0.93) trimesters. Conclusion. In pregnant women, the presence of dental plaque and first-trimester pregnancy status were the main implicated factors predicting gingival bleeding.

Bovine Tooth Discoloration Induced by Endodontic Filling Materials for Primary Teeth

Objective. This study evaluated the discoloration potential of endodontic materials used in primary teeth. Material and Methods. Dentine-enamel blocks were prepared from 75 bovine teeth, assorted in five experimental groups (n = 15). The tested materials included an MTA-based material; zinc oxide and eugenol cement (ZOE); Vitapex; and calcium hydroxide thickened with zinc oxide (Calen + ZO). The color measurements were performed using a spectrophotometer at the following intervals: prior to (T0) and after placement of the filling (T1) and after 1 week (T2), 1 month (T3), 3 months (T4), 6 months (T5), and 9 months (T6). Data were submitted to ANOVA with repeated measures and Tukeys test. Results. The time had a significant effect on the color variation (ΔE00⁎) (p < 0.0001). The effect of the materials on the color variation (ΔE00⁎) was statistically significant (p = 0.004). Interactions between time and materials demonstrated a significant effect on the values (ΔE00⁎) (p < 0.0001). The ZOE cement showed the highest darkening effect (p = 0.018). Conclusion. The MTA-based material showed the smallest discoloration during the experimental time; however, it was similar to the other materials and to the control group. Zinc oxide and eugenol showed higher discoloration.

Maternal periodontal disease and adverse perinatal outcomes: is there an association? A hospital-based case-control study

Abstract Objectives: The association between maternal periodontal disease and adverse perinatal outcomes although extensively studied remains unclear. The aim of this study was to evaluate, by a case-control study, conducted in three hospitals the association between preterm birth and/or low birth weight (PTB/LBW) and clinical parameters of maternal periodontal disease. Material and methods: Postpartum women who gave birth to a newborn PTB/LBW (case group), and postpartum women who had babies at full term with normal weight (control group) were included, in 1:2 ratio. Data were collected through medical records, interview, and periodontal clinical parameters. Bivariate analysis was performed to assess the PTB/LBW proportion relative to independent variables and multiple logistic regression analysis to assess the association between adverse perinatal outcomes and independent variables. Results: The sample consisted of 148 cases and 296 controls. By the 148 postpartum women with PTB/LBW in case group, 126 (87.5%) had preterm birth, and 75 (50.7%) had PTB and LBW. The periodontal status and generalized periodontitis presence were not associated with any adverse pregnancy outcomes. Having made four or more prenatal visits was a protective factor for all outcomes. The history of previous PTB/LBW was a risk factor for new cases of PTB and PTB and/or LBW. The presence of systemic disease was associated with preterm and low birth weight (PTLBW). Preeclampsia and cesarean delivery were associated with all outcomes. Conclusions: The clinical parameters of maternal periodontitis were not considered as a risk factor for the studied adverse perinatal outcomes. Clinical relevance: The present study demonstrated no association between maternal periodontitis and PTB/LBW.

Physicochemical and Biological Evaluation of Endodontic Filling Materials for Primary Teeth

This study assessed the pH, radiopacity, antimicrobial effect, cytotoxicity and biocompatibility of endodontic filling materials for primary teeth. Zinc oxide eugenol (ZOE), Vitapex and Calen paste thickened with zinc oxide (ZO) were evaluated in comparison to an experimental MTA-based material. Radiopacity was tested using a graduated aluminum stepwedge with a digital sensor (n=5). The materials pH was recorded at 1, 4, 12 h; 1, 3, 7, 15 and 30 days (n=5). Direct contact test was used to assess the antimicrobial efficacy against Enterococcus faecalis after 1, 4, 12, 24 h (n=5). Cytotoxicity assay used MTT test for cell viability after incubation for 1, 3 and 7 days (n=5). For biocompatibility test, Wistar rats had received implants containing each material (n=5). The biopsied tissues were histologically analyzed after 15, 30 and 60 days. The results of radiopacity, pH, antimicrobial capacity and cytotoxicity were analyzed using ANOVA and Tukey tests. The histological data were submitted to Kruskal-Wallis test. The experimental material presented the lowest radiopacity (3.28 mm Al) and had a pH>12.0 throughout the test period. The experimental material showed the highest antibacterial effect, killing over 99.97% bacteria in 4 h. Vitapex presented the highest cell viability. Initially, biocompatibility test showed moderate to severe inflammation in all groups. After 60 days, Calen+ZO group showed moderate inflammation, while the others showed predominantly mild inflammatory reaction. The present results demonstrated that the experimental MTA-based material exhibited satisfactory behavior regarding the studied properties. Additional in vivo studies are necessary for a better evaluation of the material.